Fornidd: Monotherapy and combination with other oral antidiabetic agents: The usual starting dose is one tablet 2 or 3 times daily given during or after meals. After 10 to 15 days, the dose should be adjusted on the basis of blood glucose measurements. A slow increase of dose may improve gastrointestinal tolerability. The maximum recommended dose of metformin is 3 g daily.
If transfer from another oral antidiabetic agent is intended: discontinue the other agent and initiate metformin at the dose indicated previously.
Combination with insulin: Metformin and insulin may be used in combination therapy to achieve better blood glucose control. Metformin is given at the usual starting dose of one tablet 2-3 times daily, while insulin dosage is adjusted on the basis of blood glucose measurements.
Elderly: Due to the potential for decreased renal function in the elderly subjects, the metformin dosage should be adjusted based on renal function. Regular assessment of renal function is necessary (see Precautions).
Children: In the absence of data, Metformin should not be used in children.
Renal impairment: A GFR should be assessed before initiation of treatment with metformin-containing products and at least annually thereafter. In patients at an increased risk of further progression of renal impairment and in the elderly, renal function should be assessed more frequently, e.g. every 3-6 months.
The maximum daily dose of metformin should preferably be divided into 2-3 daily doses. Factors that may increase the risk of lactic acidosis (see Precautions) should be reviewed before considering initiation of metformin in patients with GFR <60 mL/min. (See table.)
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Fornidd XR: Dosage of Metformin Hydrochloride must be individualized on the basis of both effectiveness and tolerance in patients. The maximum recommended daily dose of 2000 mg should not be exceeded.
The drug should be started at a low dose, with gradual dose escalation, both to reduce gastrointestinal adverse effects and to permit identification of the minimum dose required for adequate glycemic control of the patient. During treatment initiation and dose titration, fasting plasma glucose should be used to determine the therapeutic response to the drug and identify the minimum effective dose for the patient. Thereafter, glycosylated hemoglobin should be measured at intervals of approximately three months.
The therapeutic goal should be to decrease both fasting plasma glucose and glycosylated hemoglobin levels to normal or near normal by using the lowest effective dose.
Short-term administration of the drug may be sufficient during periods of transient loss of blood glucose control in patients usually well-controlled on diet alone.
The usual starting dose of Metformin Hydrochloride (Fornidd XR) is 500 mg once daily with the evening meal. Dosage increase should be made in increments of 500 mg weekly, up to a maximum of 2,000 mg once daily with the evening meal. If glycemic control is not achieved on 2000 mg once daily, trial of 1000 mg twice daily should be considered.
Administration: The tablet should be swallowed whole and not to be chewed. The tablet should be taken after meals.